Mumbai: The Department of Atomic Energy (DAE) and Nuclear Power Corporation (NPCIL) will begin negotiations with American nuclear energy majors following clearance of the Nuclear Liability Bill, reports PTI quoting a top NPCIL official.

"We are all set to begin talks with American companies, Westinghouse Electric Company and General Electric, and discuss how the business can happen and conclude the talks as early as possible," chairman and managing director of NPCIL S K Jain told PTI.

"Since the 'arrangements and procedures' are in place, we have to find ways and means to implement it and move forward in having collaboration with American companies in building civilian nuclear power plants during the next two decades," Mr Jain said.

The representatives of American nuclear industries also confirmed that they have been invited by DAE and NPCIL to discuss business plans inspite of the new law.

On 30th August, Parliament had adopted Nuclear Liability Bill with the government insisting that the compensation package for victims matches that of the US and it was still open to accommodate some suggestions.

Reacting to the legislation, the US yesterday said there are "couple of issues" raised by American companies about the new law and it would be "wise" for India to ensure consistency between its regulations and that of other countries.

After the passing of the legislation both DAE and Atomic Energy Regulatory Board have begun framing rules for the nuclear liability law, DAE officials said.

Regarding power plants, coming up in collaboration with Russia at Kudankulam Atomic Power Project (KAPP) in Tamil Nadu, Jain said first two units of 1000 MW each are nearing completion and fuel loading for Unit 1 is expected to take place in December and will be commissioned in January next.

The KAPP Unit 2 will be commissioned around May or June next year, he added.

About progress of KAPP Units 3 and 4, Jain said technical and commercial negotiations with Russians have been finalised and details have been worked out on indigenisation in these two units, which will be up to 60%-65% unlike the Units 1 and 2 where 100% equipment supply was from Russia.

When asked about negotiations on price, NPCIL CMD said, "few rounds of talks have taken place and few more rounds will be held to finalise it."

Levelling of ground for KAPP Units 3, 4, 5 and 6 have been completed, and tenders have been floated for excavation work for power plant Units 3 and 4, Mr Jain said.

"We are expecting first pour of concrete for Units 3 and 4 by June next year. Construction of peripheral infrastructure is being carried out on a war footing.

The fuel supply for KAPP has also been received which will last for five years from the day of commencement of plant operation, Jain said.

On imported uranium supply for Indian plants, which are under international safeguards, he said besides France, Russia and Kazakhstan (who are already supplying uranium), NPCIL is also negotiating with few more potential suppliers.

"We are also in process of keeping the units of Kakrapar Atomic Power Station (KAPS) in Gujarat under India specific IAEA safeguards by end of this year (instead of 2012 as per separation plan of the Indo-US deal) so that two more Indian plants can start using imported fuel and run the plants at 100% rated capacity."

"We have already intimated to IAEA (International Atomic Energy Agency) in this regard and surveillance instrumentation and other required arrangements for placing KAPS under IAEA safeguards are going on, and will be completed by October," Mr Jain said.

Mr Jain said the imported fuel helps NPCIL in augmenting its power producing capacity and five units of Rajasthan Atomic Power Station (RAPS) are running at full rated capacity and increased power production by more than 25% in 2009.

On the status of indigenous fuel supply, Mr Jain said Uranium Corporation of India has increased its production capacity to 60%-70% compared to last year. Hence, the plants outside the international safeguards are running at 70%-75% capacity.

Recently, the Narora Atomic Power Station (which will be placed under IAEA safeguards in 2014) received indigenous fuel and is operating at a higher rated capacity.

The construction of Kaiga Atomic Power Station Unit 4 has been completed and is waiting for Indian fuel and "We expect the commissioning of the plant to take place in November this year," Mr Jain said.

On new power plants, he said four indigenously developed 700 MW pressurised heavy water reactors will come up in the next few years with two units each at Kakrapar (Gujarat) and Rawatbhatta (Rajasthan).

Excavation work at Kakrapar is over and first pour of concrete will take place in next 2-3 weeks.

In Rajasthan, the work will commence in May or June next year but procurement and fabrication of all critical equipment and components have commenced at various Indian manufacturing industries, Mr Jain added.

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New Delhi: Finance minister Pranab Mukherjee today stuck to his conservative estimate of economic growth at 8.5% this fiscal and said the economy will be on the high expansion path at 9% in 2011-12, reports PTI.

"The latest figure released by the Central Statistical Organisation (CSO) and the latest industrial production figures clearly demonstrate it would not be difficult to achieve 9% growth as being projected in the budget from the 2011-12 and surely this year, our growth would be not less than 8.5%," Mr Mukherjee said here.

The Indian economy grew by 8.8% in the first quarter of this fiscal, the fastest growth in around three years.

The finance minister added that people think the 8.5% estimate is conservative, given that India's economy achieved 8.8% in the first quarter.

"Indian economy is back on the path of growth," he added.

Industrial growth accelerated to 13.8% in July, after dipping to just a little over 5% in the previous month.

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Taking advantage of poor knowledge of consumers, malpractices by doctors and weak regulation, drug companies are selling medicines at hugely inflated prices. We look at what a few activists have been doing to combat this menace. This is the concluding part of an exclusive Moneylife investigative series

In our previous article, we examined how the parliamentary standing committee on health and family welfare has suggested a series of measures like increasing the number of drugs under price control, a blanket cap on profit margins of all medicines and promoting the use of generic drugs to make drugs more affordable and accessible to the common man.

Moneylife spoke to Dr Chandra M Gulhati, editor, Monthly Index of Medical Specialities who debunked some of the myths about pharma company profits. This is what Dr Gulhati had to say:

Myth1 - Drug manufacturers in India do not make adequate profits and need to keep prices high

India has the highest number of pharmaceutical manufacturers in the world: 10,563 as per data compiled by the NPPA. This is because of high profitability.

The tender procurement prices for government agencies are a fraction of the MRP in India. Example: the Tamil Nadu government buys a 400mg tablet of albendazole for 35 paise while its MRP ranges from Rs6 to Rs17. Thus, even the MRP is 1,700% more than the government's procurement price. Even without taking into account promotional and middlemen's margins, the difference is appallingly high.

Ten out of the 40 richest persons on the Forbes India list are in the pharma business and even first-generation entrepreneurs have acquired massive wealth in the business. Salary packages in professionally managed companies are also very attractive and they also spend on lavish bonuses for chemists and kickbacks to doctors.

Myth2 - Competition should decide drug prices

Let's start by looking at the prices of the same molecules sold under different brand names. The variations are enormous.

1. Albendazole 400mg: Milibend, a Glenmark brand, costs Rs6/tablet while Zentel of GlaxoSmithKline is priced at Rs17: a 300% difference.

2. Two brands of amlodipine - Amlodac and Amlogard - are priced at Rs21 and Rs77, respectively, for 10 tablets: 360% difference.

5. Escitalopram, an antidepressant, also has wide variation in prices. Stalopam 10mg (Lupin) is priced at Rs6/tablet while Cipralex (Lundbeck) of similar strength costs Rs14: 230% difference.

There are hundreds of such examples. The question is: Why don't the needlessly expensive brands die a natural death in the marketplace?

1. Cyclovir (Zydus) brand of acyclovir with the therapy cost of Rs812 had a total annual sale of Rs57 lakh compared to Rs3.17 crore for more expensive Herpex (Torrent) brand with the cost of therapy at Rs1,666.

3. The most expensive brand of clopidogrel (Plavix at Rs1,020/10 tablets) sells far more (Rs12.5 crore) than the much cheaper, but equally reputed, brands including Zydus Cadila's Noklot (Rs78/10 tablets), which does not appear in the top 5 brands of clopidogrel!

Are doctors oblivious of the cost to patients? A more logical explanation is that doctors get easily 'convinced' by companies which can spend large sums of money on aggressive promotion to offer huge incentives to prescribers. This can be in various forms - of conferences abroad, high-value gifts, etc. Ultimately, the money comes from patients, since the cost of expensive gifts and lavish hospitality gets added to drug prices.

Myth3 - If drug prices are controlled, there will be no money to fund drug research

Companies expect poorer patients of India to pay the artificially high prices of existing medicines that do not involve any original research on their part. Also, while the claim is about original research, many pharma companies' balance sheets show huge reserves rather than investment in R&D.

R&D can also be encouraged through government incentives and rebates. Besides, as of date, not one successful new molecule marketed internationally has come out of India in the past four decades!

Myth4 - Indian prices are among world's lowest

The claim that drug prices in India are the 'lowest' is incorrect because most imported formulations are being sold at very high prices. The comparison must also be based on respective wage structures rather than a simple currency conversion. Also, since drug companies are paying royalties only for drugs patented after January 2005, the prices should be lower.

The Generic Option

Dr Anant Phadke is leader of the People's Health Movement in Maharashtra; he is also active with the Shramik Mukti Dal movement. The Aurangabad bench of the Bombay High Court took suo-moto note of his article in Sakaal (a popular Marathi daily) on 20 November 2009 on profiteering in the pharma trade and has appointed an amicus curiae to help in understanding the issue.

Dr Phadke had argued in his article that prices of medicines in India can be halved or brought down to a quarter, if the government takes steps to stop reckless profiteering and waste. He advocates abolition of brands as one option, but also suggests other remedies.

Two years ago, Dr Phadke started the Lokayat Medical Centre in Pune which is managed by a socially-oriented doctor under expert guidance. Patients with chronic health problems (like diabetes, high blood pressure, heart disease and infections requiring high-value antibiotics) come to the Centre for a 'second opinion' about the brand of medicine prescribed by their consultants.

Each patient's story is heard, their weight, blood pressure and other parameters verified and the findings and the treatment recorded on a case-paper. In many cases, generic medicines manufactured by LOCOST or by other reputed companies like Cipla, Dr Reddy's, Alembic or Blue Cross are available at a half to one-fourth of the price of the branded medicines prescribed by consultants. If the patient is willing to use these substitute generic medicines, they are provided to the patient at a nominal margin to cover costs including a nominal fee of Rs10 per patient that the doctor charges. Typically, an aged person who has diabetes, hypertension, high cholesterol or ischaemic heart disease saves around Rs500 per month by going to the Lokayat Medical Centre. The centre does not change the medicine prescribed by the consultant. It merely acts like a second opinion centre for the choice of the brand of medicine.

Barring exceptions, none of the doctors in Pune send their patients to Lokayat Medical Centre. But the reputation of the Centre has spread by word-of-mouth and through social activists. It has also started a Shramik Aushadhalaya (Toiling Peoples' Store) which is a generic drug store at Aajara in Kolhapur district, Maharashtra.

Dr Phadke says that general practitioners (GPs) can also make good-quality generic medicines available to their patients. In earlier days, GPs used to dispense medicines; and prescriptions were an exception. The medicines they dispensed were cheaper generic products. Socially-conscious doctors, social activists and enlightened citizens can come together to restart this healthy practice of using generics. Many hospital-pharmacies are buying drugs from the bulk market and are earning huge margins by selling at MRP. They can help to bring prices down for consumers.

Lastly, a socially-conscious doctor can decide not to prescribe a 'me-too drug'. A 'me-too drug' is one that has only a slightly different chemical composition from the regularly used older drug, with no significant difference in benefits. Yet, they are touted as superior medicines and are two to four times costlier. Dr Phadke cites Lisinopril, Ramipril, Perindopril as 'me-too' drugs that are frequently prescribed by physicians to lower blood pressure instead of Enalapril, the older, well-researched, scientifically-established medicine. All four are 'ace-inhibitors' with hardly any justification for the huge price-difference between Enalapril and others. The generic version of Enalapril 5mg costs Rs5 per strip of 10 tablets; its branded version costs around Rs20, while Lisinopril, Ramipril and Perindopril cost around Rs35, Rs70 and Rs100, respectively, for equivalent dosage! Unless the government acts to curb the galloping prices of medicines, we will require socially-oriented doctors to take the lead in helping people buy the right medicine at a reasonable price.

A Remarkable Experiment

Dr Samit Sharma, currently district magistrate, Nagaur (Rajasthan), has created history of sorts. In Chittorgarh (Rajasthan), medicines are being sold at a fraction of the maximum retail prices through 23 cooperative stores.

Dr Sharma broke the monopoly of drug manufacturers by persuading doctors to prescribe by the chemical name and made arrangements to sell medicines below the MRP at government drug counters. The demonstration effect worked. Once the choice of low-cost drugs was available to the consumer, market competition ensured that private medical shops also reduced their prices.

"If the government is serious about reducing healthcare costs, it will have to take cost-related measures - either price controls or ensuring that doctors prescribe generics. Doctors are never taught about generics in medical colleges. Many of them are simply ignorant about the efficacy of generic medicines and come around pretty quickly," Dr Sharma told Moneylife. The impact is spreading to other parts of Rajasthan too. Nine districts - including Jaipur, Bhilwara, Jalore and Sirohi - are now procuring drugs from the Chittorgarh cooperatives. In some cases, just by removing the middleman, there was as much as 95% price reduction.

Individual patients from adjoining districts have now started rushing to Chittorgarh for medical supplies. In Chittorgarh, a technical panel of doctors has pre-selected 57 drug companies (Cipla, Ranbaxy, Cadila, etc.) who are welcome to participate in the tenders. 'Surprise checks' on medicines sold through cooperatives show that they have 'same results as branded drugs'.

All this clearly is due to the extraordinary initiative of one individual. After all, the government has tried to eliminate middlemen by procuring generic drugs in bulk directly from the manufacturers and dispensing them through Jan Aushadhi (people's dispensary). But only 46 such stores have been opened till now; in a country of over 1.12-billion people, this is unlikely to make a significant dent.

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COMMENTS

amit

6 years ago

COngratulations to MoneyLife and Mr.Pradhan for talking boldly on this very important issue. If govt has to bring healthcare to the poorest of man in this country it needs to stop these greedy entities NOW. I agree to Muthu Sankar that MoneyLife needs to publish this story on a broad canvas. Also LOCOST and these good gentlement and organizations can jointly put up a website to promote FACTS about pharma industry and medicines. This organisation can act as Patient advisory body not only for medicines they are prescribed but also on hospitalization and diagnostics services.
I will be glad to help in whatever capacity I can.

Srinivasan

muthusankar

6 years ago

Well done, Money life. Thanks a lot. It is a great EYE opener for common man. Your concern for common man and the poor Indians is very much appreciated, You have brought out the real truth behind the Drug pricing and how the common man is looted by drug companies. I would appreciate if this article is published in all leading Indian NEWS papers to spread the message across the length and breadth of this country. May God Bless you to continue your sacred service. thanks.

Vilas Bhaskar Rane

You have provided eye opening truth to us. Thanks for that.

pushkar kulkarni

6 years ago

well researched article. congrats to moneylife team.my family doctor in pune gives his own tablets also has low cost subscription tabs.we need more such doctors, perhaps reliance can take a lead , they have muscle and brain to match!!it is a big opportunity- india is world's biggest market for bp/diabetis and heart problems,now that we are adopting western lifestyle,most of the bad things-junk food/ drinks, no sports ,long working hour competition to show off etc.

Mahesh

A very nice and informative series. Gave a lot of information. Please keep up the good work!

Mahesh

Very informative...Eye opener

Narendra Doshi

6 years ago

Unfortunately, I have not read the previous articles. This concluding one is a great eye openers for THE DOCTOR . May this tribe multiply exponentially. I have come across such doctors as my family doctors, fortunately, through my lifespan of around sixty years. I am a diabetic patient, due to inheritence, since last 15 yrs. KUDOS to the 'Moneylife team for bringing LIFE - moneywise'